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Acinic Cell Carcinoma: Case Report
Get PDFWe report on a 57-year-old male patient who was referred to an oral medicine specialist following an incidental finding of a buccal swelling. The patient presented with a swelling in the left buccal region of five years duration, not associated with pain or trauma. Patient gave no history of purulent discharge in the oral cavity, loss of appetite or loss of weight. Examination of the left buccal region revealed a firm non-tender mobile attached swelling of size 18 X 20 mm on the left buccal mucosa. Left parotid gland duct orifice was normal. Rest of the oral cavity was found normal with no evidence of cervical lymphadenopathy. The treatment of choice was complete surgical excision followed with 3 monthly follow-ups
Clinical outcome, risk factors and angiographic evaluation of inferior myocardial infarction with or without right ventricular involvement
Get PDFIntroduction: Assessment and quantification of right ventricular function is difficult and challenging. Nevertheless, an understanding of right ventricular function may be useful in the management of patients with an inferior acute MI that involves the right ventricle. The extent of involvement of the right ventricle varies in different series and angiographic analysis of the right ventricle can shed light on the severity of the disease. Objective: To assess the clinical outcome, risk factors and angiographic evaluation of inferior myocardial infarction with or without right ventricular involvement. Methods: This was a prospective observational comparative study carried out in National Institute of Cardiovascular diseases (NICVD) Dhaka, during the period from October 2010 to June 2011. One hundred (100) patients both group included. Among the patients we selected 50 patients with RV myocardial involvement (Group I= ST elevation >1mm in V4R) and 50 patients without RV myocardial involvement (Group II= ST isoelectric or depression in V4R). Patients admitted in CCU with AMI (inferior) fulfilling the inclusion and exclusion criteria were included in the study. According to ECG finding in right precordial lead V4R, patients were categorized into two groups. Echocardiography was done in all the patients within 24 hours of onset of chest pain. After 7 to 10 days all patients had undergone coronary angiography and then evaluation done. All data were recorded in preformed data sheet and analysis was done by computer based on SPSS program. P-value less than (< 0.05) considered as statistically significant. Results: One hundreds (100) patients were both group included. The mean age of Group I and Group II patients were (54.5±11.2 vs 54.5±11.2 years. P=0.08). The highest number of patients was in the age group (50-59) years. Majority of patients were male 94% vs. 92% respectively. On admission, chest pain was the most common presenting compliant both Groups (100% vs. 98%), breathlessness (60% vs. 24%), nausea (54% vs. 58%), vomiting (90% vs. 86%), sweating (90% vs. 98%), syncope (60% vs. 20%) and dizziness (70 vs. 28%) between Group I and Group II respectively. CAG report of coronary artery showed that 68% of the patients had lesion in proximal of the RCA in Group I. In middle of the RCA had 6% vs. 44% of patients in between Group I and Group II. The difference was statistically significant (p<0.001). There were no patients in distal part of RCA in Group I and had 36% of patients in Group II. LCX had 34% vs.26% in Group I and Group II respectively and (p=0.38). Among the studied patients, the most important frequent complications were hypotension followed by sinus bradycardia, cardiogenic shock, arrhythmias, acute LVF and cardiac arrest and death. 
Clinical utility of Continuous Positive Airway Pressure (CPAP) in Respiratory Distress Syndrome (RDS) babies and their complications.
Get PDFBackground: Respiratory distress syndrome (RDS) historically called hyaline membrane disease is mainly a developmental disorder of preterm neonates due to structural immaturity of the lungs and surfactant deficiency. The incidence of RDS is inversely proportional to gestational age and birth weight. Despite recent advancements, RDS is still the most common cause of morbidity and mortality in the newborn group.
Methods: It was a descriptive longitudinal observational study including all preterm neonates with 30-37 weeks’ gestational age and grade 1 & 2 RDS and was conducted over 2 years’ duration at a tertiary level setup.
Results: 97 neonates managed only with CPAP, all had good outcome. Out of 19 neonates managed by CPAP+ surfactant,18(94.7%) had good outcome. Out of 6 neonates managed by CPAP+ Surfactant+ Mechanical ventilation, 2(33.3%) had a good outcome and 8 neonates were managed by CPAP+MV of which 4(50%) had good outcome. 43.8%(57) preterm RDS neonates were given early CPAP and 56.2% (73) were given late CPAP. The success rate in case of early CPAP was 54 (94.7%), whereas in case of late CPAP, it was only 62(84.9%) out of 73. In early CPAP, 3 patients (5.3%) required surfactant and ventilation whereas in late CPAP 22 patients (30.1%) required surfactant and 11 (15.1%) required ventilation. Overall mortality in early CPAP was 3.5% whereas in late CPAP it was 9.6%. Only 1.7%(2) developed pneumothorax in CPAP success and 28.6%(4) developed pneumothorax among CPAP Failure cases.
Conclusion: Antenatal steroids not only play a role in reducing the severity of RDS but also in their good outcome. Early CPAP in comparison to late CPAP has a maximum survival rate, minimum mortality rate, less requirement of surfactant and ventilation support and CPAP success rate was high. Nasal trauma due to CPAP was directly related to the duration of CPAP application
Correlation of serum transaminases with dengue serology
Get PDFAim: Clinical correlation of dengue serology with serum transaminases
Introduction: Dengue, caused by dengue virus, spread by AEDES genus mosquito, is one of the most significant arthropod borne disease. In severe and less severe forms dengue may affect liver enzymes. The goal of this research was to examine and compare dengue serology with serum transaminases.
Methodology: The study comprised of 109 cases for which informed consent was taken and the patients were monitored throughout their hospital stay. Dengue antibody detection was used to confirm dengue infection and serum transaminases were monitored.
Conclusion: All types of dengue infection frequently result in elevated transaminases values with SGOT rising much more thn SGPT. Patients with NS1 antibody + dengue, have significantly higher serum transaminases levels. Also, high SGOT and SGPT values may be a poor prognostic indication and an early sign of dengue infection
Evaluation of birth weight in comparison to other anthropometric parameters to detect low birth weight
Get PDFBackground: Birth weight is an important determinant of child survival and development. Low birth weight is a major health problem in developing countries. Identification of low-birth-weight babies in the community and their screening to ascertain required level of care is very important to achieve normal goals in child survival. A large proportion of deliveries take place at home and there is need to develop simple, inexpensive, non-invasive and practical methods to identify LBW newborns soon after birth. The study was aimed to evaluate the relative usefulness and validity of chest, arm and occipito-frontal circumferences and to correlate them with birth weight to identify LBW babies. Objectives: To evaluate birth weight in comparison to other anthropometric parameters for detection of low-birth-weight babies. Methodology: This was a cross-sectional descriptive study conducted among the low birth weight babies admitted in the Pediatric wards and the low birth weight babies born in the Obstetrics wards of Rajshahi Medical college hospital to evaluate birth weight in comparison to other anthropometric parameters to detect low birth weight by measuring birth weight (BW) at or just after birth, chest circumference (CC), mid-arm circumference (MAC), occipito-frontal circumference (OFC) and to find suitable surrogates for low birth weight by comparing different parameters. Results: 350 LBW newborns were studied. Their mean CC, OFC and MAC were 30.05cm, 31.61cm and 9.68cm respectively. Mean BW was 1975gm. There was significant relationship between birth weight and gestational age (p =<0.001), chest, mid-arm and occipito-frontal circumferences (p =<0.001). There was a positive correlation of birth weight to anthropometric parameters like chest, mid-arm and occipito-frontal circumferences but the highest correlation coefficient was found with mid-arm circumference (BW-MAC: r = 0.90, BW-CC: r = 0.75 and BW-OFC: r = 0.83). Mid – arm and chest circumferences were very good anthropometric surrogates of LBW. But MAC was the best surrogate (r = 0-90) to detect LBW babies. Conclusion: Anthropometric values are simple, practicable, quick and reliable indicators for early detection of LBW newborns in a community. MAC in our perspective can effectively be used as a surrogate for LBW
New perspective with Gliclazide MR on screening and management of MODY patients in India
Get PDFMaturity-onset diabetes of the young (MODY) is a genetically heterogeneous group of monogenic endocrine disorders characterized by autosomal dominant inheritance and pancreatic β-cell dysfunction. Currently, 14 MODY subtypes have been identified, with differences in incidence, clinical features, diabetes severity and related complications, and treatment response. This type of diabetes is mostly misdiagnosed as either type 1 or type 2 diabetes mellitus because it is difficult to differentiate between these forms of diabetes due to clinical similarities, the high cost of genetic testing, and lack of awareness. The correct diagnosis for individuals with MODY is of utmost importance, as the applied treatment depends on the gene mutation or is subtype-specific. Sulphonylureas, specifically Gliclazide, has emerged as the drug of choice for MODY patients. This review will discuss the importance of screening in MODY patients and its management and the status of MODY patients in India
Comparison of the maternal and perinatal outcome in patients with BMI on pregnant women
Get PDFBackground: Pregnancy is an important event during a woman’s life. It has a great impact on her physical and mental health. All efforts that are carried out during pregnancy aim to ensure full-term pregnancy without complications, safe delivery, and a healthy baby. The prevalence of obesity or overweight in pregnancy is also rising and is of international concern.
Objective: To evaluate and compare the maternal and perinatal outcome in patients with BMI as an impact on pregnancy women.
Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to December 2021. The study included 120 singleton pregnant women with gestational age >37 weeks with cephalic presentation. The selected women were categorized into three groups of 40 each according to their BMI: Category I included normal women (BMI 20-24.9 kg/m2), Category II included overweight women (BMI 25- 29.9 kg/m2) and Category III included obese women (BMI >30 kg/m2).
Results: In the present study, 120 singleton pregnant women were equally distributed into three categories according to their BMI. In Category I (BMI 20-24.9 kg/m2), mean age of normal women was 28.5 ± 4 years in Category II (BMI 25-29.9 kg/m2), mean age of overweight women was 29.5± 4 years; and in Category III (BMI 25-29.9 kg/m2), mean age of obese women was 31.5± 6 years. There was increased incidence of antepartum complications in Category III women as compared to Category II and Category I women. The difference in the occurrence of PET among 3 categories was statistically significant (p<0.05). Similarly, the differences in the incidence of PT pregnancy, macrosomia as well as that. The mean weight of Category I (56.72 kg), Category II (65.77 kg) and Category III (80.71 kg). As regard the onset of labour as well as a mode of delivery among the 3 categories there was a statistically significant difference (p<0.05). As regards postpartum complications, only PPH was seen in 7.5% of women in Category III as compared to 5% in Category II and 5% of women in Category I. The incidence of PPH among the 3 groups was statistically not significant (P >0.05). As regards perinatal outcomes, 10% of babies born to women in Category III needed NICU admission as compared to 5% in Category II and 2.5% in Category I. There was a statistically significant difference in the incidence of NICU admissions (p<0.05). As regards still births there were 5% of babies born to women in Category III, whereas 2.5% was seen in Category II and none in Category I. There was statistically not a significant difference (p<0.05).
Conclusion: This study concluded that an increase in BMI lead to increased Incidence of Pre-eclampsia, GDM, Post-term pregnancy, and Caesarean section rate with no increase in Incidence in post-partum haemorrhage. As perinatal complications increase in BMI lead to increased Incidence of Macrosomia and NICU admission with no increase Incidence of still birth rate
Role of MRI in evaluation of cervical cancer and it’s clinical & histopathological correlation
Get PDFBackground: Cervical cancer is one of the leading causes of mortality and morbidity in women. Clinical FIGO staging has been used traditionally but due to its ineffectiveness regarding tumor extent, stromal invasion, distant organ invasion and overstaging of tumors, it is not considered the gold standard for staging of tumor. Use of MRI is now being encouraged for the pre-treatment evaluation of carcinoma cervix. Histopathology remains the most commonly utilized diagnostic tool of cervical cancers. This study was planned with the aim to compare the diagnostic performance of MR Imaging, using histology as the gold standard, with regard to the presence, size and extent of invasive cervical cancers and the detection of metastatic lymph nodes and prognosticates disease outcome and treatment modality and thus reduce the morbidity and mortality associated with the disease. Materials and methods: This study was conducted in the department of Radio diagnosis, Dr. Balasaheb Vikhe Patil Rural Medical College and Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni BK, 413736 during the period of June 2021 to June 2022. It was a retrospective study, 30 cases of clinically suspected or diagnosed as carcinoma cervix by biopsy and Pap smear, referred to the department of Radio diagnosis. Imaging was done with 3 Tesla Philips Ignesia.
Results: Among the study population, the mean age observed was 55.62 ± 15.0 years, with BMI 20.65 ± 3.29 kg/m2 and majority belonged to lower socio-economic status. The common risk factors associated with Carcinoma Cervix was multiparity (74%) and the most common presenting complaint was foul smelling vaginal discharge observed in 58% cases. 5 cases out of 30 that were diagnosed as IA on clinical examination and on MRi they were staged as IB, IIA and IIB on MRI. Rest of the cases were staged as shown in the table and the results were Statistically significant. (p value<0.007304)
Conclusion: Carcinoma cervix is primarily staged clinically as per FIGO guidelines but MRI can modify treatment options and may provide clinically important prognostic information not available from current FIGO staging. MRI also has the potential to be used as diagnostic tool for cervical cancer as it correlates strongly with histopathology
Pattern of sinonasal tumours presented in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh
Get PDFIntroduction: Sinonasal tumors most commonly arise from the nasal cavity, followed by the maxillary and ethmoid sinus; sphenoid and frontal sinus tumors are both extremely rare entities. In the sinonasal complex, squamous cell carcinoma (SCC) is the most common histology, constituting 40 to 50% of all sinonasal malignancies. Objective: To assess the pattern of sinonasal tumors presented in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Methods: This is a retrospective study carried out in the Department of ENT & Head-Neck Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh from January to June 2022. It includes 52 cases of neoplastic sinonasal growths. All cases were thoroughly evaluated including history, head and neck examination including endoscopy, imaging and histopathological examinations. All the non-neoplastic cases were excluded from the study. Details of clinical presentation, examination, radiological and histopathological findings were recorded. Results: A total of 52 sinonasal tumors presented during the period. Out of which, 41 were benign and 12 were malignant tumors. Out of 41 benign tumors, inverted papilloma was the most common comprising 12 cases (22.6%) followed by squamous (epithelial) papilloma 11 cases (20.8%), hemangioma 10 cases (18.9%), osteoma and fibrous dysplasia each 2 cases (3.8%) and ossifying fibroma, pleomorphic adenoma and angiomyoma one case each (2%). Out of 12 malignant tumors, squamous cell carcinoma was the commonest malignancy observed in the study. They were four in number (7.5%), followed by basal cell carcinoma in three cases (5.7%) and malignant melanoma in two (3.8%). Adenocarcinoma, osteosarcoma and Rhabdomyosarcoma were each one in number (5.37%) (Table-1). Nasal blockage (94.3%), nasal discharge (66.04%), epistaxis (39.6%), hemifacial pain/pressure (34%) and facial fullness/external deformities, each (18.9%) were among the commonest presentation. Conclusion: The similarities of benign and malignant disorders at initial presentation may lead to a significant delay in the diagnosis of malignancy. Key indicators of malignancy such as cranial neuropathies and proptosis are uncommon at initial presentation and signify advanced disease. Neoplasms of the nasal cavity and paranasal sinuses are rare but require a high index of suspicion for diagnosis due to the overlapping presentation between benign and malignant ones
Clinical presentation and management of post caesarean section complication admitted in DMCH as referred case
Get PDFBackground: Caesarean Section (CS) is the most frequent obstetric surgical treatment carried out today. With the development of anesthesia and method ensuing in expanded consequence and safety, its rate has been rising. Nevertheless, it includes the chance of issues ensuing in morbidity and sometimes mortality. Therefore, CSs completed barring medical indications, stay questionable. Objectives: The aim of this study is to assess the Clinical presentation and management of post-caesarean section complications admitted in DMCH as a referred case. Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Gynecology and Obstetrics, Dhaka Medical College Hospital, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2007 to June 2008. Results: Type of complication the Postpartum hemorrhage, Shock, DIC, Abdominal distension, Paralytic ileus, Hemoperitoneum, Injury to the viscera, Wound infection, Wound dehiscence, Ureter injury, Bladder injury, ruptured uterus, Intrauterine infection, Subrectal hematoma, and Anaesthetic hazards were 20(20.62%), 20(20.62%), 4(4.12%), 10(10.31%), 1(1.03%), 14(14.44%), 1(1.03%), 2(2.06%), 2(2.06%), 1(1.03%), 3(3.09%), 5(5.15%), 2(2.06%), 4(4.12%), 5(5.16) and 6(6.18%) respectfully. Conclusions: Most of the operation of the case was done of EOC and general practitioners. Most of the cases need laparotomy. Those who are working as a service provider in UCH or district hospital must have appropriate training before they start any surgery in his respective site. They must be confident enough to handle the cases